COMPARISON OF AUTOBLOOD GRAFT FIXATION VS. CONJUNCTIVAL GRAFT FIXATION WITH POLYGLACTIN SUTURE IN PRIMARY PTERYGIUM SURGERY

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BACKGROUND \nPterygium is excessive sub-conjunctival proliferation of fibrovascular tissue or elastotic degeneration of tissue under the \nepithelium. Pterygium is seen nearly twice as often in men as in women. Ophthalmologists had a real challenge for successful \nmanagement pterygium due to its high recurrence rate (2.1% to 87%). Pterygium is a local limbal cell deficiency. Pterygium \nrecurrence can be reduced if the limbus and limited area of cornea are included in the conjunctival graft, as it is well recognized \nthat limbal stem cells play a vital role in maintaining the ocular surface. \nThe objective of the study is to evaluate effectiveness and outcome of two surgical procedures for conjunctival autograft \nfixation- with autologous blood vs. polyglactin suture. \nTo evaluate the outcome of the two surgical technique in terms of surgical time, post-operative pain and discomfort, graft \nrelated complication, uptake of graft, recurrence. \nMATERIALS AND METHODS \nThis was a prospective, comparative interventional, case series of 60 eyes over a period of three years. These 60 patients were \ndivided into two group. In this study, in 30 eyes of the patients, pterygium excision with conjunctival autograft was secured \nwith 8-0 polyglactin sutures and were allocated to group A. The remaining 30 eyes of the patients who underwent pterygium \nexcision with conjunctival autograft were secured with auto blood and they were allocated to group-B. \nRESULTS \nIn this study, mean age of the patient in group-A is 44.7 ± 8.2 and in group-B 47.8 ± 8.8. Sex distribution in Gr-A- 50% were \nmale and 50% were female. In Gr-A 67.7% were male and 37.7% female. Side of involvement- in gr-A right side involvement \n76.7% and left side was 23.3%. Length of pterygium encroaching over cornea in mm (mean) S.D. 3.0 ± 0.40 in Gr-A (mean) \nS.D. 2.95 ± 0.59 in Gr-B. Vessel pattern in Gr-A. Thin vessel 33.3%, Tortuous vessels 30%, Vascular band 36.7%. In Gr-B thin \nvessel 43.7% Tortuous vessels 30.5%, Vascular band 26.3%. Operation time in Gr-A 37.3 ± 8.2 min and in Gr-B 17.5 ± 2.3 \nmin. Average time difference was 19.8 min. Regarding graft fixation time- in Group A graft fixation time was fixed for 24 hours. \nIn Group B graft fixation time was gradually decreased from 48 hours to 20 hours. In Graft related complication 20% in Gr-A \n13.3% in Gr-B. In terms of recurrence 16.7% in Gr-A and 6.7% in Gr-B and p value P<0.67 which was clinically significant. \nRelation in between recurrence & vessel pattern (vascular band). The risk of recurrence significantly increases when there in \npresence of vascular bands. The estimated risk is 1.5 with a 95% CI. \nCONCLUSION \nConjunctival auto blood auto graft is superior to suturing procedure. It is a less invasive surgery than in suturing group. It has \nless post-operative inflammation. It has less graft related complications at the end of 6 months. It has less chance of recurrence \non following up for a period of 6 months. It has early rehabilitation time. It is cost effective. It has good cosmetic effect because \nit has smooth operative surface area and has good cosmetic and functional outcome.

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